Ever since its founding in 1948, the NHS has remained a vital part of our country’s welfare state. As one of the world’s most cost-effective health systems, despite the extensive bureaucracy that remains a constant drainage, it directly contributes to the success of the British economy.

Life expectancy has been rising by five hours a day and with this comes a growing and aging population, with increased expectations for the level of care to be provided to this sector of society. Yet with the budget being stretched thin to not only improve such services, but to also match modern disease with modern medicine, deal with increased staff pressure, maintain and improve quality of care and most importantly of all keep the service afloat, the future of the NHS is a foreboding question. Public satisfaction with the NHS is higher than in all but three of the past 30 years, yet this is not the image conveyed by the media of today. Headlines such as ‘A&E wards on the brink’, ‘dismal waiting times’ and ‘is the NHS going to break?’ continue to undermine the system, with care gaps exposed, increased waiting times and mistakes flaunted by the media. Yet the increase in annual cancer survival rates nor the significant reduction in heart attacks and stroke rates are given such focus. In fact the fundamental message given off is that our NHS is failing and a drain to the treasury, whilst still being underfunded and abused.

So is 2018 going to be the turning of a new leaf? Highly doubted. The 2014 ‘Five Year Forward View’ seems to be continuing on, promising positive and effective change and reallocation of resources to cement the success of the National Healthcare Service. Yet given we are already three years in, a radical improvement remains a distant dream. One way of actually reducing costs? Addressing the market failure.

The NHS does not stand alone. With nowhere near enough funding to make its own drugs and fund processing, the public service relies upon external companies to sell mass treatments at affordable prices. External companies manipulate this to their advantage, with one such example being liothyronine, a key thyroid treatment drug. Drug company Concordia overcharged the NHS by millions, with the amount the NHS paying per pack rising from £4.46 in 2007 to £258.19 by July 2017, an increase of almost 6,000%. In other European cities, patients continue to see the drug at £5. Until earlier in 2017, Concordia was the only supplier of this drug and hence it was a clear manipulation of their market power and monopoly over the given industry. Yet it is not always the externalities that are to blame. On repeated occasions, the NHS have chosen high-priced pharmaceutical companies over cheaper alternatives, and this is where the question of political sleaze and individual gain come into place.

Take the world of ophthalmology. Age-related macular degeneration is a type of eye-disease that the NHS have been trying to address. Currently, due to effective lobbying by certain high-profile pharmaceutical firms, two drugs namely lucentis (ranibizumab) and aflibercept (eylea) are being used, however a much cheaper drug called avastin (bevacizumab), could be used instead, saving the NHS around £500 million per year. This is said to be essentially held back by regulatory framework, however sceptical doctors have made clear their concern about those who could be making changes remaining disturbingly passive. More broadly this can be seen with the issue of privatisation, with external companies charging trusts extortionate amounts to do simple cases, begging the question of what the government are going to do to address this market failure, despite the high tax benefits obviously being absorbed.

Hence it is clear that the problems facing the NHS won’t be stopping any time soon. Yet as we reach 70 years of the NHS, it is evident that the simple act of improved ethics could go a long way.

By Namitha Aravind